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Can Sleep Problems Cause Benign Positional Vertigo?

A few days after my 3rd son Brennan was born, I suffered from classic benign positional vertigo. Looking back on the course of events, I had a eureka moment last night that literally kept me up in bed.

Benign Positional Vertigo (or BPV) is a well-described inner ear condition that otolaryngologists like myself treat all the time. The classic description is when you feel dizzy, like the room is spinning, just after a sudden head movement, either up or down, or side to side. The spinning will usually last a few seconds, and you may have residual nausea and imbalance for hours to days. It’s typically preceded by an infection, head trauma, stress, or in many cases, no significant events at all (50%).

The Dix-Hallpike maneuver is performed to make the diagnosis and the Modified Epley is then continued on to cure the problem if the Dix-Hallpike is positive. In my experience, the Epley maneuver works about 80-90% of the time to cure the problem instantly if the Dix-Hallpike is strongly positive. It’s one of the more gratifying maneuvers/procedures that I perform.

When I developed BPV, I didn’t have an infection, or had any kind of head trauma. The only thing I can remember is that I was severely sleep-deprived the prior few days with all the excitement surrounding Brennan’s birth. I had the classic symptoms: spinning lasting a few seconds aggravated by sudden head turns, particularly every time I lay down in bed or rolled over to the left. After performing the Dix-Hallpike and Epley maneuver on myself, the condition got better.

The explanation for BPV is as follows: Your inner ear has three semicircular canals in three different planes, each filled with fluid and a sensor that sways back and forth, depending on which direction you turn your head. Essentially, these three paired semicircular canals tell your brain your head position. At the ends of each of these canals, there’s a sensor that sways back and forth, depending on which direction your head moves. Small calcium carbonate stones are stuck to the top of these sensors, making them sway easier.

The theory is that if one of these stones falls off, and as you move your head into a certain position, the stone moves to the top of the semicircle. Then the stone takes a few seconds to slowly move down the canal, until it reaches the bottom-most/gravity dependent position in the semi-circle. During movement of the stone, fluid waves are transmitted to the sensor which sends a one-sided signal to the brain, which thinks you’re moving your head.

Various models and even surgical findings (of otoliths, or ear stones) confirm this theory. But here’s a more plausible explanation, based on my own experience. Stones are constantly regenerated and some fall off the sensor occasionally. However, if you suffer head trauma, more stones may become dislodged and produce the symptoms. But why would a viral infection cause a stone to become dislodged? In most cases, there’s no history of infection or head trauma at all.

Any infection, whether a common cold or sinusitis, causes swelling in the nose and throat which narrows the upper airway, which narrows the throat even further, leading to more obstructions, causing more reflux, leading to more throat inflammation and narrowing. (I discuss my sleep-breathing paradigm in much more detail in my book, Sleep, interrupted.)

What’s probably happening is that sleep deprivation of any kind, including that period after a new baby is born, sleep apnea, upper airway resistance syndrome, or insomnia, can all heighten your nervous system, leading to hypersensitive sensors. It’s like when you get a migraine and certain noises or bright lights can make you cringe. In the same way, a hypersensitive inner ear sensor can over-react to any extra form of stimulation, including otoliths.

If you take this concept even further, if the other parts of the inner ear are also extra sensitive, then you can have anything from hyperacusis (sensitivities to certain sounds or voices) to ringing. This could apply to Meniere’s as well.

So ultimately, it may not be the free-floating stone, per se, that causes your symptoms, but that if your nervous system is extra sensitive to stimulation due to various forms of sleep deprivation or added stress, then you can suffer classic BPV symptoms.

Am I completely out of line, or am I on to something? Please give me your opinion in the box below.

127 thoughts on “Can Sleep Problems Cause Benign Positional Vertigo?”

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I am so glad I found this site & the comments. I have suffered from Vertigo since 2007. I used to have dizzy spells so bad I could not go to work. It has eased up over the years. Now, I’m not as dizzy, but my head feels like a vice is attached and my head & eyes feel like they are floating. This only lasts seconds, then gone. It’s almost everyday, primarily in the morning. About 4 times a week it comes on when I am driving, whenever I am changing lanes or hit a bump in the road or I turn my head a certain way. By the time I get to work, my body is exhausted and all I want to do is sleep. I suffer from sleep apnea & was wondering if this is all caused from stress & lack of sleep

That’s a wonderful idea. Even if its not the cause of BPPV per se, it may be the cause of many other types of vertigo (or add to the variance in how people are affected by bppv). The whole heightened autonomic nervous system/ lower sensory thresholds is just about impossible to get help with – youre lucky if yours had an obvious cause and then presumably goes away when the cause goes away. Not everyone so lucky…

Just found this site. I am a retired distance runner who in retirement gets bored between workouts and in order not to go out and blow money, I take a lot of short little naps…
I just like laying in a cool bed 15 minutes at a time, 5 or 6 times a day on the days I don’t go out.
I started suffering vertigo and dizziness and went to a prompt care and they gave me the standard stuff for treatment of an ear infection….Amoxicillin, mecliozine (?) and a steroid..
Its been 3 days now and I still have the vertigo…and I was wondering whether it was from the many short little naps that on many days I take.
The brain not being able to figure out what Im doing?
So, after a hard workout, I don’t take the naps anymore.
Hope this goes away..its a terrible feeling.

Seems like a logical explanation. I have vertigo,and it comes between my menstration cycles. One male gyno said not related, again what would he know. However, a woman did diagnose this, also an ENT said that i could have migraines that cause this duebto menstration. I was unaware that migraines are not headaches. Headaches are a symptom. Do you have any explanation of this?

I get this mild vertigo several times a year. I have found that each time, I have had an average of 5 to 5.5 hours of sleep maximum for a week or more, and often dehydrated as well. So I went online to see if that could be a cause, as it’s a common link. I think it is. I also have a very stuffy nose lately which could also contribute to the problem.

Could sleeping next to a partner that snores so loudly you can hear them from the front lawn of your house block cause this in the Non snoring partner. We sleep in separate rooms now but I can still hear him quite loudly but my bouts of waking with vertigo are greatly reduced, almost non existent now. Nb I also have tinnitus and recently diagnosed fibromyalgia. Would love to hear your thoughts.

The past 5 days/nights I’ve had much less sleep than normal. I woke up and felt like I was severely hung over, yet I didn’t drink much the night before. I had a few sips of a glass of wine my girlfriend was drinking and I’m very capable of drinking a couple to even a few glasses of wine and feeling perfectly fine the next morning.

I’ve had this feeling all day and I thought it would have gone away earlier in the day but it’s now 5pm and I’m still feeling this way.

I do have another issue with my right ear where it feels more congested and if I use a Q-Tip or my little finger I can hear squishy noises… almost like crinkling aluminum foil mixed with squishing liquid in a bag. Not sure really how else to describe it. I’ve had this issue since I had a few sinus procedures done to correct a deviated septum and a few other things while he was in there to open up my passageways.

But I haven’t felt vertigo and it’s been a couple years since the procedure.

So hopefully I’ll get a good night of sleep and this vertigo feeling will be gone?

Anyhow thanks for the post and if you were in Los Angeles, I’d book an appt to come see you about my sinus issues, but alas, you are in NY.

YOU MAKE SENSE, SEEM SMART N BEEN THROUGH ALOT, I HAVE MENIERE DISEASE N IN MY RIGHT EAR, FULLNESS, LIGHT RINGING N HISSING OR HUMMING,FULLNESS TO, I’M ON PREDISONE FOR INFLAMMATION SEEMS THAT RIGHT EAR GIVES ME TROUBLE N SOMETIMES MY LEFT A LITTLE, I HAD MENIERE ATTACK 10 OF 2015 N I JUST HAD ONE OVER 2 WEEKS AGO…FULNESS N HISSING OR HUMMING BUT LIGHT FOR OVER THIS TIME, LAST TIME I WOULD G9 TO SLEEP N SUDDENLY I WOULD HEAR LOUD RING N WAKE ME UP, N I GO BACK N IT HAPPENED AGAIN, MAY HAD SOME VERTIGO BUT I WAS ON VALIUMS 2MG IN MORNING OR 1MG N AT NIGHT SO IT HELPED TGE VERTIGO BUT I STILL HAD THOSE RINGING ATTACKS WITH FULLNESS N HUMMING TO, I GOT MY HEARING BACK TO PRETTY GOOD COULD TALK ON PHONE N HEAR WELL Now, I’M BACK AT AGAIN, I CAN HEAR ON TELEPHONE N BUT IS NOT REAL CLEAR BUT I UNDERSTAND, MY LEFT NO PROBLEM..VERY CLEAR BUT THAT EAR NOT AT ALL WITH THE EYSTATION TUBE ISSUE N MENIERE’S AT MOMENT I HOPE, I’M ON HIGH DOSE OF PREDISONE N VALIYM, TO HELP WITH VERTIGO N ANXIETY, BUT I CANT FALL ASLEEP WITHOUT A JERK OR A RACE TO TGE HEART LIKE A VERTIGO ATTACK OR ANXIETY ATTACK, SOMETHING HITTING SOMETHING N I READ WHAT U SAID BOUT HITTING A NETVE, COULD THAT BE? IT’S CRAZY, I HAD ISOMIA LAST COUPLE NIGHTS BUT I DIDNT HAVE NO VALIUM I THOUGHT I WAS REACTING TO THAT BUT NO BUT IT DOES HELP WITH VERTIGO N KEEPS MY ANXIETY B BLOOD PRESSURE DOWN, I NEED A ADVICE U SEEM SMART….I JUST RED TAKING B12 N I’VE ALWAYS TOOK VIT D, BUT WHY CAN’T I SLEEP WITHOUT A HERK. I SLEPT FOR 40 MIN N SOMETHING IN KITCHEN WOKE ME CAUSE WHEN I ROSE MY BOYFRIEND WAS I. THERE N TRIGGER THE SOUND I GUESS TO GET UP OR STARTLED NE I FELT LIKE MY HEART WAS RACING N DIZZY BUT WENT AWAY IN MIN…THAT’S ALL SLEEP 2 DAYS, I DONT KNOW WHAT TO GO TO HOSPITAL, HOW CAN I SLEEP THERE, I WAS TAKEN WATER PILL FOR TWO WEEKS, N THOUGHT PEE,SO MUCH MY EKECTROLUGGTS BE OFF N POTASSIUM I DONT KNOW, I WISH I KNEW,…..I HAVENT TOOK A WATER PULL TODAY….BUT I DRINK PLENTY OF WATER I AK WAYS DO…MENIERE’S IS LOW,SAKT, NO CAFFIENE, CHOCLATE, HUMMING RINGING VWRTIGO, N FULLNESS IN ONE EAR BUT LIKE I SAID I SLEPT 4 NIGHTS,AGO GOOD, N NOT SURE WHY NOW, UNLESS NOT HAVING VALIUM MY BODY WENT TO SHOCK N ANXIETY HIGH, N LOOK FOR A,SLEEP AIDE N I DIDNT HAVE ONE NOW FRST DAY, N I HAVE VAKUUM, I TOOK 2MG 11 N 1MG AT 8 TONIGHT BUT I STILL WAKE UO..I DONT KNOW IF TIME WILL HEKP, GET VS BACK IN SYSTEM OR MY BRAIN SOMETHING, I HAD ME I DONE 2015 N NO TUMOR WAS FOUND….WHAT U THINK DOC…

Thanks for posting your experiences. It’s hard to say without examining you, but in general, the fact that using a Q-Tip produces those sounds is likely due to wax flakes touching your eardrum. This is unlikely to cause vertigo. It may be two separate conditions. Th only way to differentiate between the two is to see an ENT and also undergo ear testing.

Please keep us up to date on your progress. Hopefully, you’ll be able to get some better sleep. Good luck!

I have imsomnia for about 6 years. . After 2 nights in a row of particularly crappy sleep I woke up with vertigo today. Have had vertigo all day now. I’ve never had a head injury. Looking for the cause. Any ideas? I take gravol to get to sleep and zoplicone only occasionaly when necessary.

I have sleep apnea and use a CPAP mask. I also get vertigo in bed, generally while sleeping on my right side. The bed spins are reduced with tumeric and reduced even more by controlling reflux. Controlling the reflux also seems to help reduce my feelings of apnea, especially if I also use xylitol pastels for dry mouth.

I have had The Epley Maneuver done after experiencing BPV. It was determined NOT to be Positional. I did NOT factor in Head Trauma, Sleep Deprivation, and Infection. Right now I am dealing with ALL 3. Thanks for Sharing your Keen Observations. I WILL endeavor to BE More Mindful to avert BPV.
Cynthia RN
DFW, TX

From someone who had BPV, had at least 2 Major Concussions and had in grade 6 a nose issue like a deviated septum, I am hoping my CPAP RESMED 10. should work, as I am having the machine so far 3 weeks and will go back to my supplier in March. So saying that I asked and had no answer yet. Is my nose stuffyness do to my deviated septum,, will cpap help me be better breathing person, will my 29 stop breathing stop, and will the concussion symptoms go away, so I can get a good night sleep? Doctor said even my anemia may be part of my problems? I have lots of questions and nothing so good as your book TOTALLY CPAP.

I wonder if the nose stuffiness could be due to GERD or acid reflux creeping really high up your throat as you sleep and irritates your sinuses? I’ve read that acid reflux is associated with grinding, clenching, vertigo, and possibly apneas.

If i fall asleep in an upright or tilted position [lazy boy chair]. Upon waking up,I get a bad headache,trouble breathing,nausea and a full feeling in my ears. It feels like a panic attack. Could this be [BPV] ? I get 5-6 hrs of sleep a night.

I was diagnosed with BPPV in 2014. Despite having successful treatment with Epley maneuver after my diagnosis, I still experience seemingly random recurrences. I recently discerned that all my recurrences have occurred after significant sleep deprivation. Googling the combo is how I stumbled across this page. I can’t say for sure, but my personal experiences backs up this theory.

I am 66 years old and have been helping baby sit my grandson for a week. I am exhausted and have broken sleep. I have experienced vertigo once before. This morning I woke up suddenly and it felt like my eyeballs were spinning around like a top. I think you are correct.

I totally agree on this : sleep deprivation can indeed cause vertigo. My 4 month old got her sleep regression this week and been waking up every hour at nights. This has been been happening for 4 days now. But yesterday I couldn’t even sleep during her evening nap. I was soo exhausted but had to be alert. At bedtime I found my head spinning whenever I lay down or on getting up. It stuck through the night wakings and until next morning. It somehow vanished by afternoon. Thank God!

I had gamma knife procedure on my right side to address trigeminal neuralgia atypical which I’ve had for 1 1/2 years. 1 month after the procedure my headaches have started to subside but then 2 months after I woke up with vertigo. I’ve done some of the exercises I’ve seen on the internet and determined it is the right side again that is triggering the vertigo. I only get it when I lie down, get up from lying down, or raise my head to turn over in bed. I fell dizzy during the day at times, especially if I look up. Could sleeping on my left side and avoiding my right for so long have caused this? I’ve only just recently been able to start sleeping on my right side.

I was diagnosed with BPPV in 2012 when I was severely impaired for a week with a bout of dizziness. Epley maneuver treatment helped me initially to get back to normal but I still experience dizziness once in a while. I had sleep issues before 2012 and also had suffered from ear infections but when it all started in 2012, there was no ear infection or any trauma to head. The more I suffer from sleep deprivation, the more dizzy I feel during the day. The main problem for me today is as soon as I turn over to my left side in my sleep, my sleep gets disturbed and am unable to fall asleep again. I was always convinced that there was some relationship between lack of sleep and dizziness from my own experience of 15 years, so you might be on to something.

I was recently diagnosed with Obstructive Sleep Apnea at the Severe level (69 incidents in 1 hour).
I have always been a person who snores loudly, but did not realize until now (at 67) that this was most likely OAS from an early age. For many years, I have experienced daily vertigo, which is frightening and has a significant impact on my quality of life. Your video helped me to feel not so alone (and maybe a little crazy) dealing with this awful dizzy feeling. I am
hopeful that my new CPAP treatment will lessen or perhaps eliminate the dizzies from my life. Any comment?

Directed especially to Alma Roussy: I have had insomnia for over 40 years (I’m 78 & otherwise healthy, remarkably). In 1977 and again in 1979 I experienced several weeks of normal sleep suddenly. For the first several nights I slept ten hours, which tapered off gradually until I reached what I need (about eight hours). Also, on the first several mornings I was so dizzy I could barely walk and had a painful headache, which lasted until around noon. After several days, all these symptoms disappeared, and I began to feel (and look) so much better–all my sleep-loss symptoms gone. My insomnia returned after six weeks in 1977 and eight weeks in 1979. Since then I have experienced a few shorter periods of improved sleep but nothing so dramatic as those described above. I have read nothing in sleep literature that explains this phenomenon; no sleep experts ever discussed it with me. I interpret them as long catch-up periods following long sleep-deprivation periods. I now have BPV quite often and experience frequent auras, which are migraines minus the pain.

I believe you’re on to something, Dr. Park! I’ve suffered from BPV for 15 yrs, and I’ve had constant dizziness (to a lesser extent) for the past 2 years. I’ve always been motion sensitive, ie: cars, small planes, boats, elevators. (FYI, I’m 51 and no allergies, not even seasonal, and I’m rarely sick with even a head cold; maybe one every 2-3 yrs).
After 23 yrs of complaining of EDS, I was finally diagnosed with narcolepsy after MSLT. I can’t remember ever waking up feeling refreshed, even as a child. IMO, I fit the description of UARS.
**HYPERSENSITIVE SENSORS-since the nose is so closely related to the ears, I’d like to add that I’ve always been hypersensitive to some strong odors. Anyone else? Strong candle scents, perfume, cologne, and orange solvent (commonly used in dental office labs) gives me an instant headache, verging on migraine if I don’t get away fast enough. More reason for coworkers to think I’m nuts 😔(tired, dizzy, “smell” sensitive, can’t focus or concentrate)
Thank you for your all your hard work, dedication, and continuous probing, Dr. Park!

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Dr. Steven Y. Park is an author and surgeon who helps people who are always sick or tired to once again reclaim their health and energy. For the past 13 years in private practice and 4 years in academia, he has helped thousands of men and women breathe better, sleep better, and live more fulfilling lives.

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